Thromboelastography and Liver Transplantation: A Target Group

Liver dysfunction results in derangement of hemostasis and thrombosis. Thromboelastography (TEG) has emerged as a tool to guide resuscitative efforts. We aim to identify a target population, and analyze the effects of TEG on product use and blood loss in LT. Adult patients (age \u3e18 years of age) who received LT between 2014 and 2020 were retrospectively reviewed. Those patients who underwent living donor, simultaneous or multi-organ transplants, re-transplants, and recipient \u3c18 years of age, were excluded. A subgroup analysis was done based on INR at transplant. The median, 75th, and 90th percentile of INR at transplant were used as cut-off values and patients were classified into four categories: no coagulopathy, mild, moderate, and severe coagulopathy groups. Four hundred fifty-one patients met criteria and were separated into TEG (n=144) vs non-TEG (n=307) groups. Median blood products used, and blood loss were similar between TEG and non-TEG groups (Table 1). In the subgroup analysis, there was a significant decrease in product use in the TEG group with moderate coagulopathy; Tranexamic acid (TXA) use was significantly higher in the TEG with moderate coagulopathy group (Table 2). In the no, mild and severe coagulopathy groups, there was no difference in product/TXA use or blood loss between the two groups. TEG guided hemostasis and resuscitation in LT resulted in a decrease in product usage, as well as more utilization of TXA, likely by recognition of hyper-fibrinolysis, in patients with moderate coagulopathy (INR between 2.2 and 2.8)